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Pediatric Single-Dose Fatal Ingestions Treatment & Management

  • Author: Chip Gresham, MD, FACEM; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Apr 05, 2016
 

Medical Care

Immediate care should include correction of any abnormalities of the ABCs (airway, breathing, circulation), plus two Ds: disability (ie, neurologic examination) and decontamination (ie, gastric decontamination, enhanced elimination, and antidote administration). ABC interventions should follow standard Pediatric Advanced Life Support (PALS) guidelines.

Previous advice to perform gastric decontamination for all serious ingestions is no longer recommended. Currently, gastric decontaminatio is recommended only for specific toxic ingestions, and for cases in which a formal risk-benefit analysis concludes that the probable benefits outweigh the risks.

 

 

 

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Consultations

Always consult the regional poison control center. Locate the nearest US poison control center by contacting the American Association of Poison Control Centers at 1-800-222-1222. In addition to providing advice on management and specific treatment or antidotes, poison control centers have on-call toxicologists available for physician consultations. Data on toxic ingestions are compiled through reports to the poison control centers; these data improve treatment of future patients with similar ingestions.

The need for additional medical consultation depends on the nature of the ingestion and the toxicity of the substance.

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Gastric Decontamination

The American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) maintain updated position statements on gastric decontamination. Current recommendations cover the following[79] :

  • Ipecac syrup
  • Single-dose activated charcoal
  • Multi-dose activated charcoal
  • Cathartics
  • Whole-bowel irrigation (WBI)
  • Gastric lavage

Activated charcoal

The position paper advises that use of single-dose activated charcoal may be considered if a patient has ingested, within the past hour, a potentially toxic amount of a substance known to be adsorbed to charcoal (eg, a calcium channel blocker[79]

Principal risks of activated charcoal include pulmonary aspiration (with an unprotected airway), direct administration into lungs via misplaced nasogastric tube, impaired absorption of any oral antidotes, and distraction from resuscitation of the patient.[17, 80] Thus, administration of activated charcoal is contraindicated unless the patient has an intact airway (with no risk of seizures or rapid decrease in level of consciousness) or a protected airway with confirmation of the nasogastric tube in the stomach

The dose of activated charcoal is 1 g/kg of body weight. Charcoal may be administered mixed with juice, soda, or ice cream.

Multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. However, no controlled studies demonstrate that the enhanced elimination of those drugs provides clinical benefit.

Other decontamination methods

Recommendations on other methods are as follows[79] :

  • Ipecac syrup: The routine administration of ipecac at the site of ingestion or in the emergency department should definitely be avoided; in any case, ipecac is rapidly becoming unavailable
  • Cathartics are not recommended as a method of gut decontamination
  • Gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients; in the rare instances in which gastric lavage is indicated, it should only be performed by individuals with proper training and expertise
  • WBI: Convincing evidence that WBI improves clinical outcome is lacking, but WBI can be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs (particularly for patients who present later than 2 h after drug ingestion), and can be considered for substantial ingestions of iron, lithium, or potassium
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Contributor Information and Disclosures
Author

Chip Gresham, MD, FACEM Emergency Medicine Physician and Medical Toxicologist, Department of Emergency Medicine, Clinical Director of Medication Safety, Middlemore Hospital; Senior Lecturer, Auckland University Medical School, New Zealand

Chip Gresham, MD, FACEM is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah J Buller, MBChB, FACEM Consulting Physician, Department of Emergency Medicine, Auckland City Hospital, New Zealand

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

William T Zempsky, MD Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

Ann G Egland, MD Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center

Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Cynthia L Morris-Kukoski, PharmD

Clinical Assistant Professor, Department of Pharmacy and Occupational Medicine, Medical College of Virginia

Cynthia L Morris-Kukoski, PharmD is a member of the following medical societies: American Academy of Clinical Toxicology

Disclosure: Nothing to disclose.

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